The American journal of sports medicine
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Most patients with isolated posterior cruciate ligament (PCL) injuries have minimal symptoms, and nonoperative treatment is recommended. However, over time, these patients can develop significant degenerative changes in their knees. Historically, PCL laxity is graded by nonweightbearing anteroposterior measuring techniques that do not reproduce the true, dynamic weightbearing conditions in the injured knee. The purpose of this study was to determine the patholaxity in patients with isolated PCL deficiency during functional weightbearing activities (running, walking, and stair ascent). ⋯ During functional activities, patients with isolated PCL injuries experience significant knee instability that cannot be identified by standard nonweightbearing static laxity measurements. The finding that different activities create different degrees of instability may have important implications for rehabilitation and activity limitations for PCL-deficient individuals.
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Tunnels created for reconstruction of a torn anterior cruciate ligament (ACL) are critical determinants of joint stability and clinical outcomes. There is limited objective evidence on the ability of transtibial (TT), anteromedial (AM) portal, and outside-in (OI) operative techniques in creating anatomic tunnels. ⋯ For ACL reconstruction using soft tissue grafts, tibial tunnel-independent techniques can produce more anatomic tunnels than the TT technique.
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Osteochondral lesions of the talus (OLTs) are a common cause of ankle pain and disability. Current clinical guidelines favor autogenous or allogenic osteochondral grafting procedures for lesions larger than 10 mm in diameter because of increased failure rates in these larger lesions with arthroscopic debridement, curettage, and microfracture. There are currently no biomechanical data nor level I clinical data supporting this size threshold. ⋯ The location of peak stress in the ankle joint becomes closer to the rim of the defect in OLTs at a threshold of 10 mm and greater in diameter. These data may have implications toward OLT size thresholds for surgical decision making in symptomatic lesions (ie, primary osteochondral transplantation procedure vs curettage and debridement). The ultimate goal is to determine whether there is a threshold defect size for primary osteoarticular graft techniques.
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Retrograde drilling for osteochondritis dissecans (OCD) remains a challenging operation. ⋯ The novel method improves a standard operating procedure in terms of accuracy, operation time for the retrograde drilling procedure, and radiation exposure.